HomeMy WebLinkAboutPlumbing Permit #03-1411
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec' d
/0. 2-/.03
~:~~ ~:~ PERMITNO'OI?_/~//
3 . Yellow Applicant ~
(Please type or print and sign at bottom)
ADDRESS
/5320 g/(j ht;?,Gfl/ ~~?SJ
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZ~375. OICJ.O
OWNER
(Name)
(Phone)
(Address)
APPLICANT ". j. lJ 0 J J. .J. /I.;,.
(Name) -....J~ ,1lA./h.() '~j /'7
(Address) 7>'6) /70rt<;{' Lv:'
(Address)
3oh..n /
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compa.lwent sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(Phone) 9~;2 ;239 9/22
~46>t.lr111~ ~~dl./Y'
(City) (Zip Code)
(Contact Person)
(Phone)
,PPLICANT SIGNATURE
DATE
/()--;2/-<J :J
Quantity
Type of Fixture
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Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCIIEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Permit # 03- /4-//
PLUMBING PERMIT FEE $ ::I 'lSV
STATE SURCHARGE $ .50
TOT AL PERl\'Ul FI~E $ 4(J. OU
(Office Use Only)
This Application Becomes Your Building Permit When Approved pai~/ W
DatQ-d. U. U.)l
Building Official Date (f
24 hour notice for all inspections l(952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 7-\'L
ADDRESS J n 'Z.O Dt /0 \..l~
J - .
OWNER CONTR.
PHONE NO. PERMIT NO. 5- I q \ \
o FOOTING o PLUMBIN(; RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBIN(; FINAL ~GA~IR~
o SITE INSPECTION o MECH FINAL
COMMENTS:
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
lOR ALL FOR REINSPECTION BEFORE COVERING
Inspe or: OwnE! rICo ntr:
CA L 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
DE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOJl